• AAOS CME Activity Planning for Joint Providership of Educational Activities

  • Staff Contact Information

  • Activity Information

  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Activity Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Activity End Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Educational Needs Gaps

    The provider incorporates into CME activities the educational needs (knowledge, competence, or performance) that underlie the professional practice gaps of their own learners. (https://accme.org/rule/educational-needs)

  • Provide at least two data sources used to identify the educational need or clinical practice gap described above. For the data source chosen, provide a brief description of the source and the data. C2

  • Data Sources C2*

  • Educational Objectives C2

  • As a result of participation in this activity, participants will be able to:*
  • This activity is designed to accomplish which of the following outcomes? Choose all that apply. C3

  • Planning

  • Target Audience(s) C4*

  • Type of Activity C5*

  • Educational Formats for this Activity C5*

  • Please indicate which core competencies (as described by the ABMS) will be addressed. Choose all that apply. C6*

  • Financial Information C7, C8, C9, C10

  • Will this activity be receiving commercial support e.g., pharmeceutical or medical device company support? (The ACCME definition of commercial support is as follows: A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.)*

  • If yes, please describe the type of support and the anticipated amount if available:

    Commercial Support

  • Other Anticipated Financial Support

  • In-Kind Support

  • Is another organization joint sponsoring or developing this activity?
  • Administration: Choose all that apply.

  • Evaluation

  • Course Evaluation

  • Based on the outcome determined above (competence, performance or patient outcomes), indicate the evaluation method used to analyze changes in learners achieved as a result of the program's activities/educational interventions. Choose all that apply. C11*

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